| Name: | Locust Fork Pharmacy, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 06 May 1999 (26 years ago) (Companies founded in May 1999) |
| Entity Number: | 000-664-392 |
| Register Number: | 000664392 |
| ZIP code: | 35097 (Companies in Blount, 35097) |
| County: | Blount |
| Place of Formation: | Blount County |
| Registered Office Street Address: | 30120 STATE HWY 79LOCUST FORK, AL 35097 |
| Registered Office Mailing Address: | PO BOX 52LOCUST FORK, AL 35097 |
Activities
SELL PHARMACEUTICAL AND OVER THE COUNTER DRUGS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1235240532 | 2006-08-31 | 2020-08-22 | PO BOX 52, LOCUST FORK, AL, 350970052, US | 29984 STATE HIGHWAY 79, SUITE 600, LOCUST FORK, AL, 350975878, US | |||||||||||||||||||
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| Phone | +1 205-680-2222 |
| Fax | 2056802200 |
Authorized person
| Name | MR. JOHNNY HOYT CLEVELAND |
| Role | PHARMACIST AND OWNER |
| Phone | 2056802222 |
Taxonomy
| Taxonomy Code | 183500000X - Pharmacist |
| License Number | 13351 |
| State | AL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LOCUST FORK PHARMACY (VISION PLAN) | 2021 | 462183902 | 2022-07-29 | LOCUST FORK PHARMACY | 1 | |||||||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 472506773 |
| Plan administrator’s name | KENNION & CO, LLC |
| Plan administrator’s address | 2828 OLD 280 COURT, SUITE 110, VESTAVIA, AL, 35243 |
| Administrator’s telephone number | 8669665457 |
Signature of
| Role | Plan administrator |
| Date | 2022-07-21 |
| Name of individual signing | W. HAL SHEPHERD |
| Role | Employer/plan sponsor |
| Date | 2022-07-21 |
| Name of individual signing | W. HAL SHEPHERD |
| File | View Page |
| Three-digit plan number (PN) | 951 |
| Effective date of plan | 2020-10-01 |
| Business code | 446110 |
| Sponsor’s telephone number | 2059561836 |
| Plan sponsor’s address | PO BOX 52, LOCUST FORK, AL, 35097 |
Plan administrator’s name and address
| Administrator’s EIN | 472506773 |
| Plan administrator’s name | KENNION & CO, LLC |
| Plan administrator’s address | 2828 OLD 280 COURT, SUITE 110, VESTAVIA, AL, 35243 |
| Administrator’s telephone number | 8669665457 |
Signature of
| Role | Plan administrator |
| Date | 2021-10-09 |
| Name of individual signing | W. HAL SHEPHERD |
| Role | Employer/plan sponsor |
| Date | 2021-10-09 |
| Name of individual signing | W. HAL SHEPHERD |
| Name | Role |
|---|---|
| CLEVELAND, JOHNNY | Agent |
| Name | Role |
|---|---|
| CLEVELAND, JOHNNY | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
